INVESTIGATING THE UNDERLYING CAUSES AND NOVEL TREATMENT APPROACHES FOR HYPOADRENALISM; A COMPREHENSIVE ANALYSIS OF ADRENAL INSUFFICIENCY

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Abdul Hameed
Khizer Hamza
Zaheeruddeen
Arshad Ali
Muhammad Latif
Nasir Ali
Naqeeb Ullah
Tamanna Nazir
Junaid Akhtar
Abdus Salam
Muneeb Ullah
Sohail Ahmad
Muhammad Haseeb
Salman Wali
Aiman Shafi
Kainat Khan

Keywords

Adrenal insufficiency, Infectious disease, hormonal therapy

Abstract

The aim of this study was to investigate the underlying causes, and novel treatment approaches for hypoadrenalism


Materials and Methods; This retrospective study was carried out at the department of medicine and endocrinology, Hayatabad Medical Complex, Peshawar, Pakistan, from December 2021 to November 2022. The study included 770 patients with suspected adrenal insufficiency (AI) who visited the hospital during that period. Those individuals were included who had experienced suspected AI symptoms through an adrenocorticotrophic hormone (ACTH) stimulation test, or insulin tolerance test (ITT). A peak cortisol concentration of less than 500 nmol/L (18 g/dL) was defined as AI. Patients' medical records were retrospectively analyzed for data such as age, sex, laboratory examinations, and the presence of diseases like thyroid disease, rheumatic diseases, hypertension, diabetes, respiratory diseases, or osteoporosis. All the data was analyzed through SPSS Software.  Groups were compared through the two-tailed test and data was represented in the form of standard deviation, number and percentage. P value less than 0.05 were considered significant.


Results; 770 individuals with suspected adrenal insufficiency came to the hospital and were enrolled for this study; out of which 183 (23.7%) were diagnosed with adrenal insufficiency. In this data, the number of females were n=124 (67.8%), while n=59 (32.2%) were males. The mean age was 65.65±14.42 years. Out of the 183 AI diagnosed patients, n=98 (53%) were on steroid treatment. After investigation of AI and the various types of steroids used for daily hormonal replacement therapy, our study found that hydrocortisone replacement therapy, which was given twice a day, was the most commonly used medication. The most prevalent underlying cause of adrenal insufficiency in our study was infectious diseases (70%).


Conclusion; from our study it was explored that infectious diseases is the most prevalent underlying cause of adrenal insufficiency that can be overcome by hormonal replacement therapy.

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References

1. Arlt W, Allolio B. Adrenal insufficiency. Lancet 2003; 361: 1881-93
2. W. Arlt, B. Allolio, Adrenal insufficiency. Lancet (2003);361(9372), 1881–1893
3. T. Li, J.L. Cunningham, W.P. Gilliam, L. Loukianova, D.M. Donegan, I. Bancos, Prevalence of opioid-induced adrenal insufficiency in patients taking chronic opioids. J. Clin. Endocrinol. Metab. (2020).105(10)
4. Charmandari E, Nicolaides NC, Chrousos GP. Adrenal insufficiency. Lancet 2014; 383:2152-67..
5. Sarett LH. Partial synthesis of pregnene-4-triol-17(beta), 20(beta), 21-dione-3,11 and pregnene-4-diol-17(beta), 21-trione-3,11,20 monoacetate. J Biol Chem 1946;162:601-31
6. Oelkers W. Adrenal insufficiency. N Engl J Med 1996;335: 1206-12.
7. Dorin RI, Qualls CR, Crapo LM. Diagnosis of adrenal insufficiency. Ann Intern Med 2003; 139:194-204.
8. Charmandari E, Nicolaides NC, Chrousos GP. Adrenal insufficiency. Lancet 2014; 383:2152-67.
9. Laureti S, Vecchi L, Santeusanio F, Falorni A. Is the prevalence of Addison’s disease underestimated? J Clin Endocrinol Metab 1999; 84:1762.
10. Yoo SJ, Jeong H. Diagnosis and treatment of adrenal insufficiency. Hanyang Med Rev 2012;32:203-12.
11. Regal M, Paramo C, Sierra SM, Garcia-Mayor RV. Prevalence and incidence of hypopituitarism in an adult Caucasian population in northwestern Spain. Clin Endocrinol (Oxf) 2001;55:735-40.
12. 12.Rosen T, Bengtsson BA. Premature mortality due to cardiovascular disease in hypopituitarism. Lancet 1990;336:285-8
13. Rosmond R, Bjorntorp P. The hypothalamic-pituitary-adrenal axis activity as a predictor of cardiovascular disease, type 2 diabetes and stroke. J Intern Med 2000; 247:188-97.
14. Korea Centers for Disease Control and Prevention. Korea Health Statistics 2015: Korea National Health and Nutrition Examination Survey (KNHANES VI-3). Cheongju: Korea Centers for Disease Control and Prevention; 2015.
15. Grossman A, Johannsson G, Quinkler M, Zelissen P. Therapy of endocrine disease: perspectives on the management of adrenal insufficiency: clinical insights from across Europe. Eur J Endocrinol 2013; 169:R165-75.
16. Coursin DB, Wood KE. Corticosteroid supplementation for adrenal insufficiency. JAMA 2002; 287:236-40.
17. Charmandari E, Nicolaides NC, Chrousos GP. Adrenal insufficiency. Lancet 2014; 383:2152-67.
18. Hahner S, Loeffler M, Bleicken B, Drechsler C, Milovanovic D, Fassnacht M, et al. Epidemiology of adrenal crisis in chronic adrenal insufficiency: the need for new prevention strategies. Eur J Endocrinol 2010; 162:597-602.

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